Foundational

concepts of
population Health
HLST 354-BN04
January 10th
Janet Kemei
Objectives

• Understand the World Health Organization Constitution

• Define health promotion
• Understand the difference between disease and illness
• Discuss strategies for health promotion
• Understand social determinants of health
• Understand elements of population health
 Principles of Constitution of the World Health
Organization

Health is a state of complete physical, mental and social well-being and not merely the absence of
disease or infirmity .
The enjoyment of the highest attainable standard of health is one of the fundamental rights of every
human being without distinction of race, religion, political belief, economic or social condition.

The health of all peoples is fundamental to the attainment of peace and security and is dependent on
the fullest co-operation of individuals and States.

The achievement of any State in the promotion and protection of health is of value to all.

Unequal development in different countries in the promotion of health and control of diseases,
especially communicable disease, is a common danger.
 Principles cont..

• Healthy development of the child is of basic importance; the ability to live harmoniously in a changing
total environment is essential to such development.

• The extension to all peoples of the benefits of medical, psychological and related knowledge is
essential to the fullest attainment of health.

• Informed opinion and active co-operation on the part of the public are of the utmost importance in
the improvement of the health of the people.

• Governments have a responsibility for the health of their peoples which can be fulfilled only by the
provision of adequate health and social measures.
• (The Constitution of the WHO, 1946)
 The Ottawa Charter for Health
Promotion(WHO, 1986)
Health promotion is the process of enabling people to increase control over
the determinants of health
Pre-requisites for health 
Peace
Adequate economic resources 
Food and shelter
Stable eco-system 
Sustainable resource use
Social Justice
Equity
Disease and Illness

Illness (or sickness) refers to

the individual’s experience or
Disease refers to abnormal,
subjective perception of lack of
medically defined changes in
physical or mental well-being
the structure or functioning of
and consequent inability to
the human body;
function normally in social
roles.
Three Views of Health
Biomedical
• Focuses on the causes and treatment of ill health and disease in terms
of biological cause and effect
Behavioural (lifestyle)
• Posits that people’s behaviors are primarily what cause disease  
Socioenvironmental 
• Views health more holistically as the product of one’s environment
(political, economic, and psychosocial)
Strategies for health promotions

Advocacy, Enabling, Mediating 

Create Strengthen
Re-orient
Build healthy supporting community Develop
health
public policy environments action for personal skills
services
for health health
The Epidemiological Triangle
 Social Determinants of Health
• "Why is Kibet in the hospital? 
• Because he has a bad infection in his leg.
• But why does he have an infection? 
• Because he has a cut on his leg and it got infected. 
• But why does he have a cut on his leg? 
• Because he was playing in the junk yard next to his apartment building and there was some sharp, jagged steel there that he fell on. 
• But why was he playing in a junk yard? 
• Because his neighbourhood is kind of run down. A lot of kids play there and there is no one to supervise them. 
• But why does he live in that neighbourhood? 
• Because his parents can't afford a nicer place to live. 
• But why can't his parents afford a nicer place to live? 
• Because his Mom and Dad are underemployed – making minimum wage by working in a factory. 
• But why is his Mom and Dad underemployed? 
• Because his dads credential as a doctor in Kenya has not been recognized in Canada and his mom is unable to get a professional job as an
 Social Determinant of Health according to
the World Health Organization are the
“conditions in which people are born, grow,
live, work, and age, including the health
system” which are “shaped by the
distribution of money, power, and resources
Social at global, national, and local levels” (para
1). 
Determinants
An individual's place in society, such as
of Health income, education or employment.
Experiences of discrimination, racism and
historical trauma are important social
determinants of health for certain groups
such as Indigenous Peoples, LGBTQ and Black
Canadians (Government of Canada, n.d)
Social Determinants of Health

• Why is Kibet really in the hospital?

• What determines Kibet’s health?

• What strategies exist to address Kibet’s health?

• What can Kibet and his family do to address his health?

Equality and Equity
Equality vs. Equity
Inequality and inequity

Health inequality, is a higher incidence of disease in a particular group

compared with other groups of population. If disease is randomly or equally
distributed among all groups of population, then there is no presence of health
inequality in that population.

Health inequity refers to inequalities in health that are deemed to be unfair or

unjust (social, racial, class, etc).
 Population Health
• A field of study or research approach focusing on determinants of
health in a population (Evans et al., 1994).

• “population health refers to the health of a population as measured by

health status indicators and as influenced by social, economic, and
physical environments, personal health practices, individual capacity
and coping skills, human biology, early childhood development, and
health services. As an approach, population health focuses on
interrelated conditions and factors that influence the health of
populations over the life course, identifies systematic variations in their
patterns of occurrence, and applies the resulting knowledge to develop
and implement policies and actions to improve the health and well
being of those populations.” (Dunn & Hayes, 1990, p57; ACPH, 1997)
Elements of Population Health Approach

• Focus on health of population

• Determinants of health and their interactions
• Base decisions on Evidence (qualitative and quantitative)
• Increase upstream investments
• Apply multiple strategies
• Intersectoral collaboration across all levels
• Employ mechanisms for public involvement
• Demonstrate accountability for public involvement
(Public Health Agency of Canada, 2012)
 References

• Dunn, J. R., & Hayes, M. V. (1999). Toward a lexicon of population health. Canadian Journal of Public
Health, 90(1), S7-S10.
• Evans. R., Barer, M., Marmor, T. (1994). Why Are Some People Healthy and Others Not? The
Determinants of Health of Populations. New York, NY: Aldine de Gruyter.
• Government of Canada (n.d). Social determinants of health and health inequities. Accessed
from:https://www.canada.ca/en/public-health/services/health-promotion/population-health/what-
determines-health.html
• Public Health Agency of Canada (2012). What is the Population Health Approach? Accessed from:
http://www.phac-aspc.gc.ca/phsp/approach-approche/index-eng.php 
• World Health Organization (n.d). The constitution of the World Health Organization. Accessed
from: https://www.who.int/about/governance/constitution
• World Health Organization (1986). Ottawa Charter on Health Promotion. Copenhagen, Denmark:
WHO Regional Office for Europe